In known systems for patient radiotherapy treatment, 3D X-Ray images are taken to plan a treatment process. Subsequent images (of which many dozens may be taken) may be used to position the patient, but are typically not used to re-plan and refine the treatment process, nor are subsequent images used to incrementally or in ensemble, determine anatomical changes (substantive or otherwise) with respect to an initial planning image. Known systems for patient radiotherapy treatment are also vulnerable to mis-identifying images or a patient associated with an image. This results in potentially ineffective or impaired radiotherapy treatment. A system according to invention principles addresses these deficiencies and related problems.